Obstetric fistula: challenges and approaches
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Obstetric Fistula (OF) is a devastating condition, normally caused by obstructed labor, which results in uncontrollable urinary and fecal incontinence and affects thousands of women every year. Most of the women affected by OF reside in small isolated, rural villages, creating challenges to diagnosis and treatment. Due to lack of standardization of therapy approaches, many women undergoing OF-repair often redevelop incontinence or other complications. This paper analyzes both vaginal and abdominal approaches to OF, evaluating their outcomes and the challenges they present. The therapies analyzed are: the Latzko approach, the layered-closure, and the Martius flap procedure. The goal of this paper is to determine which procedure is most appropriate to use for specific types of OF in order to establish therapeutic standardization. This study reviewed a significant amount of literature evaluating all three therapy approaches. It was determined that the Latzko approach should be utilized as the first approach to vesicovaginal fistula (WF) and vesicouterine fistula (VUF) due to its simplicity, avoidance of major operative complications, and successful postoperative repair results. Layered-closure approaches should be refrained from use, unless the Latzko approach is impossible or in specific cases of urethrovaginal fistula. Due to its more extensive operation and post-operative follow-up, the Martius flap procedures should be used only for significantly complex fistulas, such as those that involve multiple organs, are exceptionally large or recurrent. Surgical approaches, however, cannot repair the OF problem on its own, due to a number of challenges and ethical considerations. Therefore, challenges to OF treatment and repair were also considered and analyzed. A final evaluation determined that the creation of permanent infrastructure, such as women's reproductive health and delivery clinics will provide the greatest improvements to the current OF status. By solving problems such as surgeon shortages, cost issues, and the lack of follow-up and mental health services, it was determined that permanent delivery clinics with established transportation methods will produce the most significant reduction of obstructed labor, and therefore OF occurrence, and the most promising OF prevention method as well.
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